Provider Demographics
NPI:1528042967
Name:DEL CO INST DIST FAIR ACRES FARM PHARMACY
Entity type:Organization
Organization Name:DEL CO INST DIST FAIR ACRES FARM PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MULHOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:610-891-5860
Mailing Address - Street 1:340 N. MIDDLETOWN RD.
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDDLE-LIMA
Mailing Address - State:PA
Mailing Address - Zip Code:19037
Mailing Address - Country:US
Mailing Address - Phone:610-891-5860
Mailing Address - Fax:610-891-6438
Practice Address - Street 1:340 NORTH MIDDLETOWN RD.
Practice Address - Street 2:
Practice Address - City:GLEN RIDDLE LIMA
Practice Address - State:PA
Practice Address - Zip Code:19037
Practice Address - Country:US
Practice Address - Phone:610-891-5860
Practice Address - Fax:610-891-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHP416553L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty